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Interventions for pain with intrauterine device insertionAllen RH., Bartz D, Grimes DA, Hubacher D, O'Brien P
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SummaryInterventions to reduce pain during intrauterine device insertionFear of pain during intrauterine device (IUD) insertion is one reason women may not want to use this highly effective birth control method. Different ways of reducing pain during IUD insertion have been explored. These include drugs that reduce cramping of the uterus (nonsteroidal anti-inflammatory drugs, or NSAIDs), drugs that soften and open the cervix (the opening to the uterus), and drugs that numb the cervix. We searched for and summarized all the randomized controlled trials that looked at these ways of reducing pain during IUD insertion. We found four trials from four countries, with 2204 women studied. The NSAID ibuprofen at doses of 400 mg and 600 mg did not help to reduce pain during IUD insertion. Whether higher doses would have worked is unknown. Naproxen, another NSAID, may help with pain in the first two hours after IUD insertion, but the trial studying this used a larger IUD type that is not currently available. Misoprostol, a drug to soften and open the cervix, did not help to reduce pain during IUD insertion in women who had never given birth before. However, the study was not focused on women's pain, but rather the ease of placing the IUD from the provider's perspective. Currently, we have no good evidence to recommend any method of reducing pain.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
July 08. 2009 AbstractBackgroundFear of pain during intrauterine device (IUD) insertion is a barrier to use of this contraceptive method. Interventions for pain during IUD insertion include non-steroidal anti-inflammatory drugs (NSAIDs), local cervical anesthetics, and cervical ripening agents such as misoprostol. ObjectivesTo review all randomized controlled trials that have evaluated a treatment for IUD insertion-related pain. Search strategyWe searched the computerized databases MEDLINE, POPLINE, CENTRAL, and EMBASE for relevant trials. We also examined reference lists of pertinent articles and wrote to known investigators for information about other published or unpublished trials. Selection criteriaWe included all randomized controlled trials in any language that evaluated a treatment for IUD insertion-related pain. The intervention could be compared to a placebo or another active intervention. Data collection and analysisTwo authors independently abstracted data from relevant trials and data were entered into RevMan 5.0 for analysis. For dichotomous variables, the Peto odds ratios with 95% confidence intervals was calculated. For continuous variables, the mean differences with 95% confidence interval was computed. Main resultsFour trials met the inclusion criteria; the total number of participants was 2204. Nonsteroidal anti-inflammatory drugs of varying types and doses were not effective for reducing pain during IUD insertion. Misoprostol for cervical ripening did not reduce pain with IUD insertion in nulliparous women. Two trials evaluated pain that occurs after IUD insertion using nonsteroidal anti-inflammatory drugs. In one trial, naproxen taken prior to IUD insertion was effective in reducing pain compared with placebo in the first two hours after IUD insertion in mostly nulliparous women. However, this trial utilized the Dalkon Shield, an IUD with a wider diameter than modern IUDs. In another trial, ibuprofen 600 mg taken before IUD insertion did not show evidence of an effect on pain four to six hours after IUD insertion. Authors' conclusionsNo interventions that have been properly evaluated reduce pain during or after IUD insertion. One poorly controlled trial suggested that topical lidocaine gel may reduce insertion-related pain and warrants further investigation. |